The socioeconomic distribution of non‐communicable diseases in Europe: findings from the European Social Survey (2014) special module on the social determinants of health

Background: A range of non‐communicable diseases (NCDs) has been found to follow a social pattern whereby socioeconomic status predicts either a higher or lower risk of disease. Comprehensive evidence on the socioeconomic distribution of NCDs across Europe, however, has been limited. Methods: Using cross‐sectional 2014 European Social Survey data from 20 countries, this paper examines socioeconomic inequalities in 14 self‐reported NCDs separately for women and men: heart/circulatory problems, high blood pressure, back pain, arm/hand pain, foot/leg pain, allergies, breathing problems, stomach/digestion problems, skin conditions, diabetes, severe headaches, cancer, obesity and depression. Using education to measure socioeconomic status, age‐controlled adjusted risk ratios were calculated and separately compared a lower and medium education group with a high education group. Results: At the pooled European level, a social gradient in health was observed for 10 NCDs: depression, diabetes, obesity, heart/circulation problems, hand/arm pain, high blood pressure, breathing problems, severe headaches, foot/leg pain and cancer. An inverse social gradient was observed for allergies. Social gradients were observed among both genders, but a greater number of inequalities were observed among women. Country‐specific analyses show that inequalities in NCDs are present everywhere across Europe and that inequalities exist to different extents for each of the conditions. Conclusion: This study provides the most up‐to‐date overview of socioeconomic inequalities for a large number of NCDs across 20 European countries for both women and men. Future investigations should further consider the diseases, and their associated determinants, for which socioeconomic differences are the greatest.

[1]  P. Philippot,et al.  Socioeconomic inequalities in depression: a meta-analysis. , 2003, American journal of epidemiology.

[2]  R. Bilous,et al.  Diabetes prevalence and socioeconomic status: a population based study showing increased prevalence of type 2 diabetes mellitus in deprived areas , 2000, Journal of epidemiology and community health.

[3]  Morgen M. Miller,et al.  Computing Adjusted Risk Ratios and Risk Differences in Stata , 2013 .

[4]  T. Koepsell,et al.  Formal education and back pain: a review , 2001, Journal of epidemiology and community health.

[5]  Martin McKee,et al.  UN High-Level Meeting on Non-Communicable Diseases: addressing four questions , 2011, The Lancet.

[6]  N. Poulter,et al.  Socio-economic status and blood pressure: an overview analysis , 1998, Journal of Human Hypertension.

[7]  C. Di Lorenzo,et al.  Epidemiology of constipation in children and adults: a systematic review. , 2011, Best practice & research. Clinical gastroenterology.

[8]  C Borrell,et al.  Socioeconomic differences in the prevalence of common chronic diseases: an overview of eight European countries. , 2005, International journal of epidemiology.

[9]  J. Mackenbach,et al.  Socioeconomic inequalities in cardiovascular disease mortality; an international study. , 2000, European heart journal.

[10]  P. Littlejohns,et al.  The relationship between severe asthma and social class. , 1993, Respiratory medicine.

[11]  T. Platts-Mills,et al.  Association of specific allergen sensitization with socioeconomic factors and allergic disease in a population of Boston women. , 2001, The Journal of allergy and clinical immunology.

[12]  J. Mackenbach,et al.  The association between socioeconomic status and changes in health in Europe , 2008 .

[13]  R. Fitzgerald,et al.  The First Pan-European Sociological Health Inequalities Survey of the General Population: The European Social Survey Rotating Module on the Social Determinants of Health , 2016 .

[14]  Reinhard Busse,et al.  Tackling Chronic Disease in Europe: Strategies, Interventions and Challenges , 2010 .

[15]  C. Borrell,et al.  Socioeconomic position and type 2 diabetes mellitus in Europe 1999-2009: a panorama of inequalities. , 2011, Current diabetes reviews.

[16]  L. Radloff The CES-D Scale , 1977 .

[17]  T. Schrecker,et al.  The double burden of neoliberalism? Noncommunicable disease policies and the global political economy of risk. , 2016, Health & place.

[18]  Katia Levecque,et al.  Gender differences in depression in 23 European countries. Cross-national variation in the gender gap in depression. , 2010, Social science & medicine.

[19]  H. Williams,et al.  The problem of atopic eczema: aetiological clues from the environment and lifestyles. , 1998, Social science & medicine.

[20]  N. Talley,et al.  Low socioeconomic class is a risk factor for upper and lower gastrointestinal symptoms: a population based study in 15 000 Australian adults , 2001, Gut.

[21]  E. Friedman Socioeconomic inequalities in cardiovascular disease mortality. , 2001, European heart journal.

[22]  D. Allison,et al.  Misuse of Odds Ratios in Obesity Literature: An Empirical Analysis of Published Studies , 2012, Obesity.

[23]  M. Marmot,et al.  Socioeconomic circumstances and common mental disorders among Finnish and British public sector employees: evidence from the Helsinki Health Study and the Whitehall II Study. , 2007, International journal of epidemiology.

[24]  P. Allebeck,et al.  Type 2 diabetes incidence and socio-economic position: a systematic review and meta-analysis. , 2011, International journal of epidemiology.

[25]  J. Mackenbach,et al.  Socioeconomic status and ischaemic heart disease mortality in 10 western European populations during the 1990s , 2005, Heart.

[26]  T. Volmer The socio-economics of asthma. , 2001, Pulmonary pharmacology & therapeutics.

[27]  G. Kraaykamp,et al.  Education, educational heterogamy, and self-assessed health in Europe : A multilevel study of spousal effects in 29 European countries , 2010 .

[28]  Jason Beckfield,et al.  Health Inequalities in Global Context , 2013, The American behavioral scientist.

[29]  M. Wickman,et al.  Low socioeconomic status as a risk factor for asthma, rhinitis and sensitization at 4 years in a birth cohort , 2005, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[30]  Lenore J. Launer,et al.  The prevalence and characteristics of migraine in a population-based cohort , 1999, Neurology.

[31]  G. Kaplan,et al.  Sociodemographic characteristics, life stressors, and peptic ulcer. A prospective study. , 1995, Journal of clinical gastroenterology.

[32]  H. Keçeci,et al.  Epidemiological and Clinical Characteristics of Migraine in Sivas, Turkey , 2002, Headache.

[33]  Martin McKee,et al.  Caring for People with Chronic Conditions: A Health System Perspective , 2008 .

[34]  T. Huijts,et al.  Prevalence of physical and mental non‐communicable diseases in Europe: findings from the European Social Survey (2014) special module on the social determinants of health , 2017, European journal of public health.

[35]  A. Hjern,et al.  Social class in asthma and allergic rhinitis: a national cohort study over three decades , 2005, European Respiratory Journal.

[36]  B. Jackson,et al.  Chronic Obstructive Pulmonary Disease and SocioEconomic Status: a Systematic Review , 2012, COPD.

[37]  Gert P Westert,et al.  Health disparities by occupation, modified by education: a cross-sectional population study , 2007, BMC public health.

[38]  H. Graham,et al.  Obesity and health inequalities , 2007, Obesity reviews : an official journal of the International Association for the Study of Obesity.